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Lamotrigine for preventing seizures

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Lamotrigine for preventing seizures

This leaflet is about the use of lamotrigine to prevent epileptic seizures. (Seizures may also be called convulsions or fits.)

This leaflet has been written specifically about the use of this medicine in children. The information may differ from that provided by the manufacturer. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Name of drug

Lamotrigine

Brand name: Lamictal®

Why is it important for my child to take this medicine?

It is important that your child takes lamotrigine regularly so that they have fewer seizures.

What is lamotrigine available as?

Tablets: 25 mg, 50 mg, 100 mg, 200 mg; contain lactose

Dispersible tablets: 2 mg, 5 mg, 25 mg, 100 mg

When should I give lamotrigine?

You will usually start by giving lamotrigine once a day, or every other day, while your child gets used to the medicine. This can be in the morning OR evening.

When your child is used to lamotrigine, you will usually give it twice a day: once in the morning and once in the evening. Ideally, these times are 10–12 hours apart, for example sometime between 7 and 8 am and between 7 and 8 pm.

How much should I give?

Your doctor will work out the amount of lamotrigine (the dose) that is right for your child. The dose will be shown on the medicine label.

When you first start giving lamotrigine to your child, you will give them a small amount and then increase the dose bit by bit over a few days or weeks. This helps your child to get used to the medicine. Your doctor will explain what to do.

It is important that you follow your doctor’s instructions about how much to give.

How should I give it?

Tablets should be swallowed whole with a glass of water, milk or juice. Your child should not chew the tablet.

You can crush the tablets and mix them with about 2 tablespoons of fruit juice or soft food (e.g. yogurt, honey or mashed potato). Make sure your child swallows it all straight away.

Dispersible tablets: Dissolve the tablet(s) in water or fruit juice. Mix it vigorously – it will make a cloudy mixture. Draw up the right volume into an oral syringe. Your doctor, epilepsy nurse or pharmacist will tell you how much liquid to use, and how much of the mixture to give your child. If there is any mixture left, do not keep it for another time or pour it down the sink – squirt it into a kitchen towel and then put this in the rubbish

Your child can chew the dispersible tablets. They should then drink a glass of water, milk or fruit juice.

When should the medicine start working?

It may take up to 6 weeks for lamotrigine to work properly, so your child may still have seizures during this time. This is because the amount of medicine has to be increased slowly. Continue to give the medicine in the way you have been told to by your doctor or epilepsy nurse. Lamotrigine may not stop your child’s seizures completely. If you are worried about whether it is helping, contact your doctor but continue to give the medicine.

What if my child is sick (vomits)?

If your child is sick less than 30 minutes after taking a dose of lamotrigine, give the same dose again.

If your child is sick more than 30 minutes after taking a dose of lamotrigine, you do not need to give them another dose. Wait until the next normal dose.

If your child is sick again, seek advice from your GP, pharmacist or hospital. They will decide what to do based on your child’s condition and the specific medicine involved.

What if I forget to give it?

If you are giving it once every other day: Give the missed dose when you remember, as long as this is at least 12 hours before the next dose is due.

If you usually give it once a day in the morning: Give the missed dose when you remember during the day, as long as this is at least 12 hours before the next dose is due.

If you usually give it once a day in the evening: If you remember before bedtime, give the missed dose. You do not need to wake up a sleeping child to give a missed dose. You can give the missed dose in the morning, as long as this is at least 12 hours before the evening dose is due.

If you usually give it twice a day: If you remember up to 4 hours after you should have given a dose, give your child the missed dose. For example, if you usually give a dose at about 7 am, you can give the missed dose at any time up to 11 am. If you remember after that time, do not give the missed dose. Just give the next dose as usual.

Never give a double dose of lamotrigine.

What if I give too much?

If you think you may have given your child too much lamotrigine, contact your doctor or local NHS services (111 in England and Scotland; 0845 4647 in Wales) or take your child to hospital.

Take the medicine packaging with you, even if it is empty. This will be useful to the doctor. Have the packaging with you if you telephone for advice.

Are there any possible side-effects?

We use medicines to make our children better, but sometimes they cause effects that we don’t want (side-effects).

Side-effects that you must do something about

If your child develops a blotchy red skin rash, contact your doctor straight away, as your child may be allergic to lamotrigine. The rash may be anywhere on the body, and you may also see blisters in the mouth. This reaction is most likely to be seen during the first 8 weeks of taking lamotrigine. It is more likely if your child is already taking another medicine for epilepsy called sodium valproate.

If your child has such a rash and is also generally unwell and has a fever (high temperature above 38°C) or unusual bruises or bleeding, take them to your doctor or hospital straight away, as this may indicate a more serious reaction.

Your child’s skin may become more sensitive to sunlight. Keep them out of strong sun. When outdoors, they should wear a long-sleeved top, trousers and a hat and should use a high-factor sun screen (at least SPF 30).

Other side-effects you need to know about

Your child may be drowsy (sleepy) when they first start taking lamotrigine. This should get better after a few days as your child gets used to the medicine. If it doesn’t, contact your doctor but continue to give lamotrigine.

They may develop a tremor (shakiness), their coordination may be affected (they may seem clumsy) or they may have blurred vision. They may also have changes in mood and may be aggressive or hyperactive (more active than usual and finding it hard to relax). They may have sleep disturbances, such as difficulty getting to sleep. If you are worried contact your doctor.

If you notice any other side-effects and are concerned, contact your doctor. You can report any suspected sideeffects to a UK safety scheme at http://www.mhra.gov.uk/yellowcard.

Can other common medicines be given at the same time as lamotrigine?

You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.

Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.

Epilepsy and pregnancy

Pregnancy presents a risk to both the mother with epilepsy and her unborn baby. If your daughter has sex, it is essential that she uses adequate contraception to prevent an unplanned pregnancy.

If your daughter is worried that she may be pregnant, it is important that she sees your family doctor as early as possible. Your daughter should keep taking her medication until she sees her doctor.

Lamotrigine and pregnancy

Lamotrigine may harm an unborn baby.

The oral contraceptive pill may not work properly in women or girls who are taking a high dose of lamotrigine.

Lamotrigine may not work properly in those taking the oral contraceptive pill or in pregnancy.

General advice about medicines for seizures

Do not suddenly stop giving any of these medicines to your child, as they may have a seizure. If you are worried, talk to your doctor but carry on giving the medicine to your child as usual.

If your child seems to have more seizures than usual, contact your doctor or epilepsy nurse.

If your doctor decides to stop a particular medicine, they will discuss this with you. You will usually reduce the dose bit by bit.

Do not change the dose of any drug without talking to your doctor first.

It is best that your child always has the same brand of each medicine, as there may be differences between brands. Keep a record of which medicines your child has.

Try to give medicines at about the same times every day, to help you remember.

Only give the medicine(s) to your child. Never give them to anyone else, even if their condition appears to be the same, as this could do harm.

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.

Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine?

Keep the medicine in a cupboard, away from heat and direct sunlight.

Make sure that children cannot see or reach the medicine.

Keep the medicine in the container it came in

Who to contact for more information

Your child’s hospital doctor, epilepsy nurse or pharmacist will be able to give you more information about lamotrigine and other medicines used to treat epilepsy.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.